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Health & Place 18 (2012) 757765

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Health & Place


journal homepage: www.elsevier.com/locate/healthplace

Review Essay

Crime, fear of crime, environment, and mental health and wellbeing:


Mapping review of theories and causal pathways
Theo Lorenc a,n, Stephen Clayton b, David Neary b, Margaret Whitehead b, Mark Petticrew a,
Hilary Thomson c, Steven Cummins d, Amanda Sowden e, Adrian Renton f
a

Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
Department of Public Health and Policy, University of Liverpool, Whelan Building, Liverpool L69 3GL, UK
c
MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ, UK
d
School of Geography, Queen Mary University of London, Mile End Road, London E1 4NS, UK
e
Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
f
Institute for Health and Human Development, University of East London, Water Lane, London E15 4LZ, UK
b

a r t i c l e i n f o

abstract

Article history:
Received 6 December 2011
Received in revised form
6 March 2012
Accepted 6 April 2012
Available online 19 April 2012

This paper presents the ndings from a review of the theoretical and empirical literature on the links
between crime and fear of crime, the social and built environment, and health and wellbeing.
A pragmatic approach was employed, with iterative stages of searching and synthesis. This produced
a holistic causal framework of pathways to guide future research. The framework emphasises that
crime and fear of crime may have substantial impacts on wellbeing, but the pathways are often highly
indirect, mediated by environmental factors, difcult to disentangle and not always in the expected
direction. The built environment, for example, may affect health via its impacts on health behaviours;
via its effects on crime and fear of crime; or via the social environment. The framework also helps to
identify unexpected factors which may affect intervention success, such as the risk of adverse effects
from crime prevention interventions as a result of raising awareness of crime.
& 2012 Elsevier Ltd. All rights reserved.

Keywords:
Crime
Fear of crime
Mental health
Wellbeing
Built environment
Review

1. Background
Crime and the fear of crime have been identied as potential
mediators between neighbourhood characteristics and mental
health and wellbeing outcomes (Jenkins et al., 2008), as promising
loci of interventions to improve wellbeing (Department of Health,
2010; Department of Health, 2011), and as important dimensions
of wellbeing in their own right (Stiglitz et al., 2009). Similarly,
theories of the determinants of mental health have focused on
crime as a major explanatory factor: for example, the VicHealth
framework in Australia includes freedom from discrimination and
violence as one of the three key determinants of mental health,
along with social inclusion and economic participation (Herrman
et al., 2005; Keleher and Armstrong, 2005). In addition, participatory research has identied crime and antisocial behaviour as an

Corresponding author. Tel.: 44 2079272778.


E-mail addresses: theo.lorenc@lshtm.ac.uk (T. Lorenc),
stephen.clayton@liverpool.ac.uk (S. Clayton),
david.neary@liverpool.ac.uk (D. Neary), mmw@liverpool.ac.uk (M. Whitehead),
mark.petticrew@lshtm.ac.uk (M. Petticrew),
hilary@sphsu.mrc.ac.uk (H. Thomson), s.c.j.cummins@qmul.ac.uk (S. Cummins),
ajs18@york.ac.uk (A. Sowden), a.renton@uel.ac.uk (A. Renton).
1353-8292/$ - see front matter & 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.healthplace.2012.04.001

important inuence on wellbeing (Burke et al., 2009; OCampo


et al., 2009).
Thus, crime and fear of crime are widely recognised as potentially important inuences on mental health and wellbeing. They
also exemplify the kinds of complex environmental factors which
may only be partially illuminated by quantitative observational
studies alone (Cooper et al., 2008). Synthesising and understanding
the complex links between physical environmental mechanisms,
social norms and imagery, and simultaneously incorporating the
impact of distal factors which cannot be captured in a linear concept
of causality, demands a exible approach which can integrate
heterogeneous types of evidence (Cummins et al., 2007). Investigating such links also demands the integration of research from a
range of disciplines, not only those directly related to health and
wellbeing.
The primary aim of this paper is to present a holistic framework tracing the theoretical links between crime, fear of crime,
the environment and health and wellbeing. The framework
presented here was developed as part of a broader evidence
synthesis project, which will include systematic reviews of the
effectiveness of interventions in the built environment to improve
health and wellbeing through addressing crime or the fear of
crime, and of qualitative evidence relating to fear of crime and the

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T. Lorenc et al. / Health & Place 18 (2012) 757765

built environment. Within this context, the framework is


designed to facilitate an understanding of the contexts within
which policy-makers and practitioners might seek to improve
health and wellbeing by addressing crime and fear of crime.
A secondary aim is to use the framework as a methodological
case study, to illustrate one possible way of constructing theory in
the context of undertaking evidence synthesis of the effectiveness of
complex social interventions. The value of theory-led approaches,
particularly those that generate causal pathway frameworks, is now
widely acknowledged (Anderson et al., 2011; Craig et al., 2008).
However, in relatively few cases have such frameworks been set out
in detail, supported by a discussion of underlying theories and
empirical evidence. Previous research has emphasised a logic
model approach which is limited to elucidating the internal pathways of interventions, and does not lend itself either to a broader
contextualisation of interventions, or to a critical engagement with
the theories they embody. The approach set out below represents an
attempt to remedy some of these limitations. Thus, this paper may
also be seen in the context of the ongoing debate about the role of
theory in informing systematic reviews, particularly reviews of
complex interventions.

2. Methods
We employed a pragmatic approach, with iterative stages of
searching and synthesis, inuenced by realist review (Pawson et al.,
2004), critical interpretive synthesis (Dixon-Woods et al., 2004,
2006) and the causal mapping method of Baxter et al. (2010).
The aim was to generate a framework incorporating relevant
theories and evidence on pathways to guide the broader project.
The construction of the framework took place in three phases
within the overall iterative process. The initial phase attempted to
catalogue the main theories linking the central concepts of crime,
fear and crime and health and wellbeing, and develop a metatheoretical framework to integrate them. Many of these theories
were found to draw upon broader concepts (the physical and
social environment, and policy-level factors) which were then
included in the framework in their own right. This then induced a
second phase in which the theoretical links between these further
concepts and the original foci of interest were explored. Finally,
where the theoretical literature was not directly based on empirical ndings, we carried out further targeted searches to locate
empirical evidence on the associations posited by the theories.
Search sources included targeted database searches and suggestions from subject experts within the review team and the Advisory
Group; there was also a strong emphasis on pearl growing methods
such as citation chasing. The selection of studies prioritised those
which helped to shape the emerging meta-theoretical constructs,
and was initially pursued to the point of theoretical saturation with
respect to the framework. Where the theories were conicting or
underdetermined, further searches were undertaken to identify
empirical studies reporting data and associations between variables
relevant to the theory, with a view to at least an indicative
judgement of the theoretical claims. Thus, the main foci in terms
of data were theoretical literature and quantitative observational
studies of associations between variables, although we also utilised
qualitative evidence, outcome evaluations, policy papers and a range
of other types of evidence.

Fig. 1. Overview theoretical model

Fig. 2 presents the more detailed model, in which the six main
areas are disaggregated into sub-concepts (with some areas of
overlap) and the links set out in more depth. The main areas are
shown as large hollow boxes, the sub-concepts as smaller shaded
boxes, and the links as arrows.
The main concepts and sub-concepts are as follows.

 Crime and disorder includes all types of crime and antisocial


behaviour;

 Fear of crime includes two main dimensions: the perceived





likelihood of victimisation (the cognitive dimension) and the


emotional response to the possibility of crime (the affective
dimension);
Health and wellbeing is an inclusive concept including
physical and mental health outcomes, health behaviours, and
social wellbeing;
Built environment includes all factors relating to the physical
environment insofar as they are shaped by human activity;
Social environment has been conceptualised on the basis of a
previous review of theories (McNeill et al., 2006), and includes
social inequalities and interpersonal networks, as well as the
distribution of social factors in space (neighbourhood and
community factors), which overlaps with the built environment; and
National policies and economic factors includes all broader
policy or economic factors which may have an impact on crime
or fear.

Due to limited space and resources, not all of the potential links
identied in Fig. 1 have been dealt with in detail in the review. In
particular, we have excluded the social, political and economic causes
of crime from our scope (i.e. the links going from the social
environment and national policy to crime). In addition, we have not
considered the policy-level determinants of other factors in any
detail; national policy is included in the framework mainly as a
reminder that all the factors are shaped directly or indirectly by
macro-level determinants. These limitations of scope should be borne
in mind in interpreting the framework.
In the following sections we discuss the links between these
concepts and their sub-concepts.

3. Results
3.1. Crime, health and wellbeing
Fig. 1 provides a graphical overview of the model derived from
our review, showing the six key conceptual areas identied and
the potential links between them.

Crime may inuence health in a range of ways (Hirscheld,


2004). A distinction can be made between direct and indirect

T. Lorenc et al. / Health & Place 18 (2012) 757765

Avoidance
behaviours

Fear of
crime

Emotional
responses

Perceived
individual risk

Individual
attitudes

Perceived
crime rate

Cognitive

Individual
demographics

heuristics

Perceived
physical
environment

and

759

Health and
wellbeing

Mental
health

Health
behaviours

Interpersonal
relationships
& networks

Physical
health

biases
Perceived
social
environment

Social
inequalities
Social
environment

Individual
crime risk
Crime and
antisocial
behaviour

Housing and
public space

Neighbhood
& community
factors

Built
environment

Social
representations
and mass media

National policies and


economic factors

Fig. 2. Detailed theoretical model

impacts (McManus and Mullett, 2001). Direct impacts include


both physical injuries and psychological trauma as a result of
being victimised. Most direct impacts arise from violent crimes
against the person (although non-violent crimes such as burglary
may also have direct psychological impacts on victims). These
direct impacts are represented in the framework by the link from
crime to physical and mental health. Indirect impacts include a
wide range of negative effects which crime can have on wellbeing
at an ecological level, apart from its direct effects on victims. Most
of these effects are likely to operate mainly at neighbourhood
level, and are represented in the framework as several distinct
pathways linking crime and wellbeing via physical and social
environments, the perceived environment, and fear of crime.
The direct impacts of personal victimisation, particularly of
serious and violent crime, on individual victims health have been
the focus of most studies of crime and health (McCabe and Wine,
1997; McManus and Mullett, 2001; Robinson and Keithley, 2000).
A substantial body of literature documents these direct physical
and mental health impacts on victims, which are often substantial
and long-lasting, and unequally distributed across the population
(see for example Norris and Kaniasty, 1994; Russo and Roccato,
2010). Domestic crimes, including child abuse and intimate
partner violence, may have particularly serious health impacts

(Campbell, 2002; Coker et al., 2002; Fanslow and Robinson, 2004).


The signicance of these direct impacts at a population level is
unclear. Violent crimes occur relatively rarelyapproximately 40
incidents per 1000 people per year in England and Wales (Home
Ofce, 2012)so the impact of their direct effects on the health of
the general population is likely to be limited. However, due to the
unequal distribution of crime, the impact on certain groups may
be greater.
The indirect impacts of neighbourhood crime on health and
wellbeing are more complex in nature. Area-level violent crime
has been found to be associated with a range of negative health
status outcomes, including all-cause mortality (Wilkinson et al.,
1998), coronary heart disease (Sundquist et al., 2006), and
preterm birth and low birth weight (Messer et al., 2006), as well
as with health behaviours such as lower physical activity (Gomez
et al., 2004; McDonald, 2008). Exposure to violence in the areas in
which people live is also known to be associated with poorer
physical and psychological health, particularly for children and
young people (Boynton-Jarrett et al., 2008; Fowler et al., 2009).
However, although these associations are well-established, the
causal pathways involved remain open to debate. One mechanism
which has been of interest to sociological researchers is the diffuse
effect of structural inequality and disadvantage in conjunction with

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T. Lorenc et al. / Health & Place 18 (2012) 757765

repeated victimisation or the threat of victimisation. Such latent


structural violence may particularly affect women, people from
ethnic minorities and people of lower socio-economic status, and
has been encapsulated in the concept of spirit injury (Walklate,
2007; Spalek, 2008).
Health itself may also have an impact on crime: people with
health problems, particularly serious mental health problems,
may be at greater risk of being the victims of crime (Choe et al.,
2008; Maniglio, 2009; Teplin et al., 2005). This is represented in
the model by the pathway from mental health to crime.
Finally, health behaviours are also included as a dimension of
wellbeing in the model, and may themselves be linked to crime.
Alcohol consumption is of particular interest here. At an individual level, problem drinking is known to be associated with
violent offending (Shepherd, 2007); at an area level, alcohol outlet
density is associated with alcohol consumption and related
harms, including injuries and violence (Campbell et al., 2009;
Popova et al., 2009). However, as in the example above, the
direction of the causal relationships underlying these associations
are not entirely clear.
3.2. Fear of crime and health and wellbeing
The framework includes four potential pathways connecting
fear of crime to health and wellbeing outcomes.
(1) The anxieties induced or expressed by fear of crime may have
an impact on mental health, and indeed may be considered a
wellbeing outcome in themselves.
(2) Poorer health, particularly mental health, may exacerbate fear
of crime.
(3) Fear of crime may lead to avoidance behaviours such as
limiting ones movement outside the home, which may have
a negative impact on (a) social interaction and (b) physical
activity.
(4) Fear of crime may have an impact on social wellbeing at an
ecological level.
Pathways 1 and 2 are difcult to disentangle empirically, as
they link the same types of outcomes in opposite directions. The
link itself is fairly well-established: several studies have found
that affective measures of fear of crime are associated with poorer
mental and physical health, although effect sizes are generally
modest (Beatty et al., 2005; Chandola, 2001; Green et al., 2002;
Roberts et al., 2010; Ross, 1993; Ross and Mirowsky, 2001;
Stafford et al., 2007). There is also some evidence of an association
between cognitive measures (perceived crime or risk of crime)
and poorer health outcomes (Kitchen and Williams, 2010; White
et al., 1987), although the ndings here are less consistent, and
other studies nd no association (Bowling et al., 2006; Johnson
et al., 2009).
However, while pathway 1 is likely to account for at least
some of this association, pathway 2 may also have some effect, in
that poor health, particularly mental health, may increase perceived vulnerability and hence fear of crime (Whitley and Prince,
2005). People in poor health have been found to be much more
likely to report that fear of crime has a high impact on their
quality of life: 20% for those with bad or very bad health,
compared to 5% for the general population (Allen, 2006). Whereas
much fear of crime, as measured by standard instruments,
appears to be benign and functional (Jackson and Gray, 2010),
people with mental health problems are disproportionately likely
to experience fear which has a substantial impact on wellbeing
(Whitley and Prince, 2005). This has implications for the planning
of interventions: if pathway 2 rather than pathway 1 explains
much of the observed association between fear of crime and

health, then reducing crime and the fear of crime may have
limited potential to improve health and wellbeing. This said,
longitudinal data suggests that pathway 1 does have a signicant
impact independently of pathway 2 (Stafford et al., 2007). Rather
than simply coexisting with pathway 1, pathway 2 may interact
with it, in a vicious circle or feedback loop between fear of crime
and ill-health (Jackson and Stafford, 2009).
Pathway 3 links fear of crime to wellbeing via the avoidance
behaviours adopted to lessen the perceived risk of victimisation.
Many of these are everyday precautions which are likely to have
little impact on wellbeing (e.g. locking doors). However, others
may limit individuals activities to a considerable extent, as they
reorganise their lifestyles to avoid areas or activities perceived as
involving exposure to risk. For women particularly, extensive
constraints on behaviour resulting from fear may become internalised and normalised as an attitude of constant vigilance, with
pervasive and potentially serious consequences for wellbeing
(Campbell, 2005; Condon et al., 2005; Pain, 1997, 2000; Stanko,
1997).
These avoidance behaviours may be linked to health and
wellbeing outcomes in two ways. First (pathway 3a), avoidance
behaviours may limit interpersonal interaction, leading to poorer
mental health (Stafford et al., 2007). Again, there may be a
feedback loop here whereby limiting social interaction also
increases fear in its turn (Liska et al., 1988). Second (pathway
3b), they may limit outdoor physical activity, hence leading to
poorer physical health. This pathway has received considerable
attention in the theoretical literature (Loukaitou-Sideris and Eck,
2007), although the empirical ndings are mixed (Carver et al.,
2008; Foster and Giles-Corti, 2008).
Pathway 4 hypothesises that fear of crime leads to decreased
trust and cohesion within communities and to individual withdrawal, with a series of feedback loops at ecological and policy
levels leading to progressive decline in social and physical environments, which then impact negatively on wellbeing (Skogan, 1986;
Vanderveen, 2006). This can be seen as an extended loop which goes
from fear of crime to interpersonal relationships, and from there
(as part of the social environment) directly and/or via the built
environment to the perceived environment and back to fear of
crime. However, while this pathway has received considerable
theoretical attention, many of the posited links are difcult to
substantiate empirically.
Of the seven studies of associations between fear of crime and
health cited above, two attempt to quantify the relative importance of these pathways. Ross (1993) investigates psychological
distress (pathway 1) and physical activity (pathway 3b), and
Stafford et al. (2007) physical activity (pathway 3b) and social
interaction (pathway 3a), as potential mediators. Both nd that a
substantial amount of the association is explained by these
pathways, but not all. This may indicate that broader, more
diffuse connections, such as those hypothesised in pathway 4,
play a role in the health and wellbeing impacts of fear of crime.

3.3. Crime and fear of crime


The link between crime and fear of crime is more complex
than it may initially seem. This is partly because the concept of
fear of crime is beset by issues of denition and measurement.
It has been widely argued that standard measures of fear of crime
tend to reect general anxiety or unease, or broader perceptions of
the social and physical environment, rather than anything specically to do with crime (Farrall et al., 1997; Garofalo and Laub, 1978;
Taylor and Jamieson, 1998). Empirical studies have generally found
little relation between objectively measured probability of victimisation, or even actual experience of victimisation, and individuals

T. Lorenc et al. / Health & Place 18 (2012) 757765

fear or estimates of their own risk (Farrall et al., 2007; Hale,


1996).
Thus, there does not appear to be a reliable direct link between
crime and fear of crime (the so-called riskfear paradox (Farrall
et al., 2007)). Two implications may be drawn from this. The rst
is that fear of crime may be driven less by crime itself than by
factors such as the physical environment or interpersonal relationships; these theories are examined in the following sections.
The second, going back to the classic work of Tversky and
Kahneman (1974), is that the link between crime and fear may
be inuenced by various biases and pragmatic procedures for
estimating risk (cognitive heuristics) which lead to inaccurate
assessments of risk. For example, the anchoring and adjustment
heuristic involves using a single piece of information as an
anchor for estimates of risk and adjust other information to
t. This may help to explain the nding that most people think
crime is much worse at a national level than in their local area:
media coverage of serious violent crime forms the anchor for
estimates of risk, and peoples direct experience of less serious,
more high-volume crimes is adjusted accordingly (Moon et al.,
2009). Such heuristics may also explain the potential for intensive
policing interventions to increase fear by raising awareness of
crime (Hinkle and Weisburd, 2008). They may act on a social as
well as an individual level through the social amplication of
risk (Jackson, 2006; Pidgeon and Kasperson, 2003); the mass
media may be particularly important here, although individual
media consumption does not appear to be strongly associated
with fear of crime (Chadee and Ditton, 2005; Ditton et al., 2004).
More broadly, the distinction between rational and irrational
or symbolic fear which underlies much work on the crimefear
relation (Elchardus et al., 2008) has been criticised as inadequate
for understanding the place of fear in individuals lives (Jackson,
2009; Lupton and Tulloch, 1999; Sparks, 1992). In particular, the
concept of spirit injury mentioned above indicates the inadequacy of labelling as irrational any fear driven by factors other
than the incidence of crime. For example, womens fear of rape
appears to be substantially inuenced by the experience of dayto-day sexual harassment, threats, and relatively minor sexual
crimes such as indecent exposure (Valentine, 1989). It is thus
considerably more grounded in reality than the simplistic juxtaposition with objective risk of rape would suggest.
3.4. Built environment and health and wellbeing
The main theoretical frameworks linking factors in the built
environment to health and wellbeing invoke some form of
environmental stress theory, which sees wellbeing as determined
by the balance between environmental stressors, such as noise,
trafc, poor housing, or overcrowding, and countervailing protective factors, such as social integration (Halpern, 1995; Northridge
et al., 2003). Such theories are well-supported by empirical
studies of associations between these stressors and mental health
outcomes (Evans, 2003; Halpern, 1995).
Crime and the threat of crime can readily be integrated into
this type of theory as part of the complex of environmental
stressors (Ellaway and Macintyre, 1998). The environmental
stress concept is thus a useful framework for thinking about
crime and fear of crime as mediators between environmental
determinants and health outcomes. In addition, it supports the
idea that the cumulative effect of everyday stress and anxiety can
have a substantial effect on wellbeinganalogous to Arline Geronimus weathering hypothesis (Geronimus, 1992; Geronimus et al.,
2006)which helps to ll out the broader picture of the impacts of
crime beyond its direct physical effects on victims.
The framework represents the potential inuences of the built
environment on health in terms of three main pathways. The built

761

environment may affect health via its impacts on health behaviours


(Humpel et al., 2002; Saelens and Handy, 2008); via its effects on
crime or fear of crime; or via the social environment.
3.5. Built environment and crime
A range of features of the built environment have been
hypothesised to have an impact on crime rates. The majority of
the literature on these impacts focuses on identifying features of
the built environment that provide opportunities for criminal
acts, which may then be adjusted to reduce or prevent crime
(Robinson, 1999). Some of these theories have adopted a distinction between crime science, which emphasises situational
opportunities for crime, and (traditional) criminology, which
focuses more on the social, economic and political determinants
of crime.
Several strategies in the built environment have been shown
by high-quality systematic reviews to be effective in reducing
crime, including improved street lighting (Welsh and Farrington,
2008b) and, in a limited range of contexts, closed-circuit television (Welsh and Farrington, 2008a). Environmental design
approaches are effective in reducing robberies in retail settings
(Casteel and Peek-Asa, 2000), although there is little robust data
on such approaches in residential or community settings (Eck,
1998).
The most inuential theoretical paradigm has been Crime
Prevention Through Environmental Design or CPTED. CPTED
emphasises three key concepts as mediators between the physical
environment and crime and other negative outcomes: ownership
or territoriality; surveillance; and access control (Cozens et al.,
2001; Robinson, 1999). CPTED theorists recommend specic
design practices to increase these mediators, for example, clearly
demarcating public from private space, and removing visible
signs of neglect (litter, grafti, etc.), to promote territoriality
(Taylor, 2002); improving visibility to increase surveillance; and
limiting points of entry to control access.
CPTED has been widely inuential among policy-makers,
particularly in the USA and the UK, and has been incorporated
into initiatives such as Secured by Design, which recommends the
integration of crime prevention into the planning process
(Armitage, 2004). However, CPTED has been criticised for focusing
on local-level initiatives which may merely displace crime to
other areas (Cozens et al., 2005); for focusing on public outdoor
spaces to the neglect of private or domestic spaces (Davies, 2008);
and for encouraging a bunker mentality, leading to reduced
social cohesion as communities withdraw behind the barriers of
defensible space (Cozens et al., 2005).
In addition, there is limited empirical support for many of
CPTEDs more distinctive claims about territoriality and surveillance
(although the potential for interventions in the built environment to
reduce crime is well established in general). Much of the empirical
literature on built-environment factors and crime (reviewed in
Schneider and Kitchen, 2007) consists of cross-sectional observational studies with inadequate controlling for confounders, and
systematic reviews are lacking, so the reliability of this literature
is limited. However, more recent and methodologically sophisticated research, particularly using the space syntax approach to
model social interactions in space, has reported some promising
results which may validate some of the predictions of the theory
(Hillier and Sahbaz, 2007; Friedrich et al., 2009).
3.6. Built environment, social environment, national policy and fear
of crime
The built and social environment may have an impact on crime
rates, and the latter on fear of crime. In this sense, the environment

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T. Lorenc et al. / Health & Place 18 (2012) 757765

may have an impact on fear indirectly, by providing information


about crime rates, which individuals then build into their risk
perceptions. However, as we have seen, fear of crime may also
express broader dissatisfactions with the environment. Hence, the
environment may impact on fear of crime directly, independently of
its effects on crime, by inducing feelings of threat, anxiety or
alienation which are expressed as fear.
Two main theoretical approaches to the impacts of the environment on fear of crime can be found in the literature (Crank et al.,
2003; European Crime Prevention Network, 2004; Franklin et al.,
2008; Kanan and Pruitt, 2002; Vanderveen, 2006). Incivilities
theory or social disorder theory emphasises the role of subcriminal but antisocial activities in the local environment, and
of evidence of neglect and decay, in the genesis of fear of crime.
The concept of incivilities here includes both problems in the
built environment, such as vandalism and abandoned properties,
and problems in the social environment, such as people dealing or
using drugs. (The term broken windows, introduced by Wilson
and Kelling (1982), has often been used as an umbrella term for
such approaches, although it has taken on other connotations in
its convergence with zero tolerance policing (Harcourt and
Ludwig, 2006).) Social integration theory emphasises the role of
local-level social networks as determinants of fear. To these two
we can add CPTED theory, whose hypotheses about the inuence
of the environment on crime have often been extended to claims
about the inuence of the environment on fear of crime.
Incivilities theories appear to be fairly well-supported by
observational data, which show a consistent association between
perceived social and physical incivilities and perceived risk or fear
of crime (Box et al., 1988; LaGrange et al., 1992; Lewis and
Maxeld, 1980; Perkins and Taylor, 1996; Robinson et al., 2003;
Scarborough et al., 2010; Wyant, 2008). Some ndings indicate
that incivilities are more strongly associated with the cognitive
dimension of fear (perceived risk) than the affective dimension
(LaGrange et al., 1992; Rountree and Land, 1996), and more
strongly with fear of property crime than with fear of personal
crime (LaGrange et al., 1992).
However, other research indicates that an individuals perception of social and physical disorder is a better predictor of their
fear than objectively assessed measures of these problems
(Taylor, 1995; Taylor and Hale, 1986). This nding has suggested
to some researchers that the observed association between
disorder and fear may result less from individuals using disorder
as an indicator of risk than from the social meanings of environmental conditions (Curtis, 2010), such that their relation is more
an expressive link than a causeeffect relationship (Hope and
Hough, 1988).
Social integration theory is less well-supported; indeed, even
the predictions to be drawn from it are ambiguous. Some
researchers suggest that fear of crime may be mitigated by social
support, while others argue that higher social interaction may
increase fear of crime by increasing communication about crime
(Skogan, 1986). The empirical literature does not suggest a
relationship in either direction (although such a relationship
may be obscured by the heterogeneity of the outcome measures
used). Some studies nd an association between stronger social
interaction or cohesion and lower fear of crime (Gibson et al.,
2002; Riger et al., 1981; Scarborough et al., 2010). However, many
studies nd no consistent association (Clarke and Lewis, 1982;
Green et al., 2002; Kanan and Pruitt, 2002; Roman and Chaln,
2008; Ross and Jang, 2000; Sacco, 1993; Shields et al., 2003).
CPTED-type theories of the determinants of fear are also not
fully conrmed by the data. For example, CPTED theory predicts
that larger building size will be associated with lower territoriality, and hence with higher fear, but the empirical ndings are
mixed (Newman and Franck, 1982; Normoyle and Foley, 1988).

Finally, although few data were located on policy-level determinants of fear of crime, one study nds that more generous
social welfare policies are associated with higher levels of
perceived safety (Hummelsheim et al., 2011).

4. Conclusions
This review illustrates the multiple and complex nature of the
theoretical links between crime, fear of crime, the environment
and health and wellbeing. It is well-established that crime has
substantial direct health and wellbeing impacts on individual
victims. Indirect area-level links between crime and health, for
example through the effects of chronically high crime rates on
social relationships, are less well established. Crime may be
inuenced by the physical environment, although limited robust
evidence is available. Fear of crime appears to have a modest
adverse effect on wellbeing, and on health behaviours such as
physical activity. Fear of crime may be substantially inuenced by
physical environmental factors, such as neglected and run-down
environments; its relation to the social environment is less clear.
The concept of fear of crime is unclear, and the validity of many
commonly used quantitative measures is widely questioned;
it appears to be only loosely related to crime.
Although substantial bodies of theory and evidence exist in
many of the subelds included in the framework, this paper
reports what we think is the rst attempt to produce a synthesis
of the diverse literatures to provide an overarching representation
of the theoretical pathways between the environment, crime, fear
of crime, and health and wellbeing. Our review also indicates
several areas in which systematic reviews would be of value,
particularly the association between fear of crime and health
outcomes; and built-environment correlates of crime and fear of
crime. However, any such work would need to take into account
the methodological challenges of synthesising evidence on the
fear of crime, particularly the questionable reliability of many
standard measures.
The review has certain limitations, resulting both from the
methodology adopted and from the nature of the underlying
evidence. The review did not employ formal systematic review
methods, and the methods employed were open to bias in terms
of both the selection and interpretation of the underlying data.
A wide range of material was used to construct the framework,
from broad, abstract theory to quantitative studies of specic
associations, and different areas vary widely in terms of the
nature of the evidence supporting them. Within fear of crime
research in particular, we can distinguish between a more
positivist tradition which is reliant on quantitative evidence,
and a more critical tradition, based primarily on qualitative
research and incorporating insights from critical and feminist
sociology; these have long been distinct paradigms, and only
relatively recently have researchers tried to draw them together
(e.g. Farrall et al., 2009). In several cases, especially with respect
to the purported riskfear paradox, these paradigms may not
only generate conicting ndings and narratives, but disagree
fundamentally on the very nature of the phenomena to be
examined.
As noted above, this review could not encompass all relevant
factors. In particular, the framework does not cover the social,
economic and political determinants of crime. In addition, a
number of areas are covered only in summary terms, and would
benet from more detailed investigation, for example, the interactions between different dimensions of wellbeing, and the
psychological mechanisms underlying judgements about and
affective reactions to the environment.

T. Lorenc et al. / Health & Place 18 (2012) 757765

Another recurring issue is the difculty of establishing the


directionality of causal relationships from theories and observational data alone. In particular, further work on the relation
between fear of crime and mental health along the lines of
Stafford et al. (2007) would be valuable. Finally, while the
graphical representation of the model is a useful tool to communicate the ndings, it should not be taken too literally; in
particular, the impression that the various concepts are discrete
and well-dened, and the links between them homogenous, may
be misleading.
We can tentatively propose the following more distal causal
pathways linking crime and the fear of crime, and their environmental cues, to health and wellbeing. First, crime and fear of
crime may have a substantial impact on wellbeing for certain
groups within the population, such as people with mental health
problems. Second, fear of crime is linked to health outcomes at an
ecological level as part of a wider complex of environmental
stressors. Third, fear of crime measures may express broader
dissatisfaction with the environment.
However, in a number of areas there is less evidence for causal
linkages. Generally, there appears to be limited reason to think
that crime or the fear of crime, taken in isolation, are major
determinants of health or wellbeing outcomes (or mediators of
environmental determinants) for the general population at an
ecological level. In particular, it is hard to establish pathways
from crime to health outcomes, for several reasons: pathways via
fear of crime are subject to considerable uncertainty; direct health
impacts on victims of crime, while often serious for individuals,
appear to be of limited importance at population level, due to the
relatively low incidence of serious violent crime; and the strong
correlation of both types of outcome with material disadvantage
makes it difcult to test hypotheses about specic independent
pathways between crime and health.
The potential implications for interventions are, therefore, also
mixed. The framework suggests that interventions in the physical
environment which reduce the fear of crime may have some
benecial impacts on health and wellbeing at a population level.
Several different wellbeing dimensions might show positive
impacts of such interventions, including mental health, health
behaviours, and social relationships. The potential for environmental interventions which focus on crime prevention to improve
wellbeing is less clear, and there is some possibility of negative
effects if interventions increase awareness of crime, and hence
fear. The framework suggests that interventions which integrate
crime reduction into a broader set of objectives, and address other
environmental determinants of wellbeing, are more likely to
positively inuence wellbeing outcomes. However, a robust
systematic review of empirical data is required to conrm this
hypothesis.
More generally, the potential challenges which the framework
identies for interventions in the physical environment indicate that
other factors may be more promising loci of intervention. In
particular, addressing determinants of crime in the social environment or at the policy level may be a more effective way to improve
wellbeing. However, this lies beyond the scope of the present review.
On a methodological level, the work described in this paper
indicates the feasibility and value of undertaking a wide-ranging
exercise in meta-theory construction, based on a disparate body
of theories and evidence, in order to inform evidence syntheses of
complex social interventions. As has been claimed for logic
model approaches in general, the framework promotes an understanding of the internal mechanisms of interventions. However,
the approach outlined here goes beyond this to provide an outline
of the broader context within which interventions take place, and
hence helps to identify unexpected factors which may affect
intervention success. For example, it illustrates the risk of adverse

763

effects from crime prevention interventions as a result of raising


awareness of crime. Finally, it provides a conceptual vocabulary
which can translate between divergent constructs, and hence may
assist in producing a coherent synthesis of evidence on a wide
range of interventions.

Acknowledgements
This project was funded by the National Institute of Health
Research (Grant no. 09/3000/14). The views expressed are those
of the authors and do not necessarily reect those of the NIHR.
We would like to thank the members of the project Advisory
Group (Allan Brimicombe, John Middleton, James Thomas, Rachel
Tufn and Sandra Walklate).

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